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Medscape
14-07-2025
- Health
- Medscape
Balancing Act: MS Care for Women Considering Pregnancy
This transcript has been edited for clarity. My name is Dr Patricia K. Coyle. I'm professor of neurology and director of the Stony Brook Multiple Sclerosis Comprehensive Care Center at Stony Brook University in Long Island, New York. I'm going to be talking about the treatment of women with multiple sclerosis (MS) from the ages of 18-40 years. Now, that really defines the prototypic MS patient— a young woman of childbearing age. Pregnancy is a key issue. In fact, expert consensus and treatment guidelines indicate that it's mandated to discuss family planning in appropriate, newly diagnosed and diagnosed MS individuals. That's very, very important. The healthcare provider, in discussing family planning, should indicate to the prototypic patient that pregnancy in MS is not considered a high-risk pregnancy. In fact, MS has very little impact on pregnancy. There is no negative impact. Fertility is not affected. There's no increase in spontaneous abortions. There's no increase in birth defects. You can do any sort of anesthesia or delivery. MS is really not a key factor in that. Now, one of the things that we do want is a planned pregnancy. We don't want a surprise pregnancy in someone with MS where we haven't thought things out. That should be discussed with the individual. In addition, it's interesting that the majority of pregnant women [in studies] have relapsing MS and do not have any significant disability. We can speak very confidently about what happens in relapsing MS with little-to-no disability with regard to pregnancy, but there's a lack in understanding of more disabled MS individuals and particularly progressive MS. In fact, in pregnancy cohorts, 87%-97% are relapsing MS, not progressive. We really need to have more studies in progressive MS and more disabled [individuals with] MS. Often when we're making the diagnosis of MS, that young individual, when we discuss family planning, may really say that they want to plan to have a child right away. Well, expert consensus indicates that we should counsel against that. In fact, expert consensus says that the best pathway in a newly diagnosed MS individual is to treat them for at least 1-2 years in more active or more concerning MS before the planned pregnancy occurs. Why is that? Data are accumulating, showing that there's a window of opportunity early in the MS disease process to optimally control the damage process. You want to treat early, you don't want patients to wait a couple of years as they try to get pregnant and have a child. They would be better off investing in controlling their MS disease process and then electively going ahead with the pregnancy. What would we counsel in the pre-pregnancy period? First, we need to know about disease activity. There was a famous PRIMS study published in the late 1990s that mapped the annualized relapse rate in French women, largely relapsing MS, and they found it was stable in the pre-pregnancy period. It went down during pregnancy, went further down so that the third trimester had the lowest relapse rate, and then temporarily rebounded after giving birth for a several-month period before ultimately settling down to the pre-pregnancy baseline. Now, why is that? Well, there are immune changes and hormonal changes during pregnancy that could be considered treatments for MS disease activity. You see the disease activity go down during pregnancy. There's really an immune tolerance going on [whereby the mother doesn't attack] the foreign fetus. There's a switch from T helper 1 cytokines, which would enhance cell-mediated immunity, which is more prominent in MS, to T helper 2, where you have more humoral antibody immunity that's favorable to MS. Actually, MS disease activity goes down during the pregnancy. If we're going to have planned pregnancy, we have to discuss contraception. Any contraception can be used in MS, but there should be a discussion in family planning around what the patient is doing to avoid becoming pregnant. We should put a word in to our patients for long-acting, reversible contraception, which is clearly the most effective. The failure rate is less than 1%. This is using an [intrauterine device] or an implantable rod that is the most effective contraception, and we should actually speak favorably about that to our patients. Another issue is genetics. Many patients will ask, 'Can I pass MS onto my child?' Some may not ask that, but it's a worry for almost everybody. That should be formally discussed. We know there are about 233 or more genes that control risk susceptibility, and then there are probably disease severity genes and disease protection genes. You don't have any gene that can pass on MS. MS is not considered an inherited disease, so that's important to emphasize to individuals with MS. DMT Management 'What about disease modifying therapy (DMT) washouts as a person is preparing for their pregnancy? What DMTs do not need to be washed out?' With glatiramer acetate (GA) and interferon beta, there have been thousands of human pregnancy exposures and no negative data. They need no washout. They can be stopped once the person documents that they're pregnant. By expert consensus, it's the same with the fumarates. The half-life of these agents is an hour or less. It's washed out within a day, and there are no human pregnancy data suggesting harm from the fumarates. By expert consensus, it's accepted that you would take a fumarate until you got pregnant and then discontinue it. Most recently, the anti-CD20 agents— at least the ones that we have a long history with, such as ocrelizumab, ofatumumab, and rituximab— the Association of British Neurologists in the United Kingdom has published that they believe that you could try to get pregnant immediately after an anti-CD20 infusion. [The guidelines also recommended that women taking ocrelizumab should preferably wait 3 months before trying to conceive.] Why is that the drug labels continue to indicate waiting 6 months? Well, it's very hard to change labels. It takes a great deal of time and effort to do that. An anti-CD20 is an immunoglobulin G antibody. This is not a toxic chemical. It's also passed by the placenta, but the half-life is such that if you were to stop the anti-CD20 at the time of pregnancy, it would be largely washed out before there would be any concern about exposure of the fetus. Really, you don't need to wash out the anti-CD20s, and I explain that to patients. What about pregnancy counseling? Could you use a DMT during pregnancy? It's accepted. GA, yes, there are several hundred cases. Interferon beta, yes, but many people would prefer not to be on a disease-modifying therapy that they might not need. In addition, believe it or not, natalizumab is typically used during pregnancy. Why? Well, because stopping it can result in rebound relapses in a pregnant individual, which leaves them with disability. It's very common to continue using extended dosing of the natalizumab every 6 weeks, up to about weeks 30-34, then discontinuing it and arranging to have the baby delivered by 40 weeks. Suppose there's a rare relapse during pregnancy. Can you do an MRI scan? Absolutely. MRIs are safe during pregnancy. We don't want you to use gadolinium-based contrast agents. The fetus can be exposed to gadolinium, so you would not use gadolinium unless it was absolutely vital to the medical question that you were asking. Could you treat a relapse during pregnancy? Yes, you could use steroids. You would certainly not use dexamethasone. You would use methylprednisolone or prednisone, and you would use it short term, the typical treatment for an acute relapse. Some people might not like to use that in the first trimester. There's old literature that suggests an increased risk of cleft lip or palate, but the newer data don't suggest that that is a real risk. Depending on the severity of the relapse, you could go ahead and use steroids as necessary. What about postpartum counseling? First of all, we have to counsel that there's an increased risk of MS activity and breakthrough relapses in MRI scans in the several months after they deliver the baby. The World Health Organization has recommended breastfeeding for 6 months after giving birth. It appears that breastfeeding is somewhat protective, that MS disease activity goes down with breastfeeding, and it seems as though exclusive breastfeeding is more important. Do you want to know what the good news is? Monoclonal antibodies can be used in breastfeeding individuals, so you can reinstitute the monoclonal antibody DMT without concern, and certainly GA and interferon beta can be resumed. You have very little detectable DMT in the breast milk and the baby's gut will 'chew it up' anyway. The only DMTs that you don't want to use in breastfeeding are the oral agents because there's not enough data about the exposure there. MS and Fertility Issues Now let me move to one final point. I want to speak about fertility issues, assisted reproduction technology and in vitro fertilization (IVF). I think every neurologist should be aware of oocyte cryopreservation. Women are born with about 1-2 million eggs. By puberty, they have 300,000 eggs left. By menopause, there are [a limited number of] eggs left and the eggs age. You can collect eggs — it should be done before the age of 37 — and cryopreserve them for a later pregnancy if that is a concern. I finally want to make a point about how dependent we are on getting new information so that we can give the latest updates when counseling our MS individuals. There were several, a total of five, small-scale studies over several years that indicated that MS individuals who went through IVF and failed to get pregnant had breakthrough MS activity for about a 3-month period. They were very small-scale studies, but we actually counseled patients about this. In the last few years, we've had major studies with much larger numbers of MS individuals who went through IVF, and it turns out that was false. They could not document any increase in relapses whatsoever. In general, there was a tendency to maintain their disease-modifying therapy right up to, and even through, the IVF technique. Therefore, we've changed our counseling. It turned out, in studies with a larger number of participants, IVF is quite safe for MS individuals. I want to thank you very much for listening.
Medscape
18-06-2025
- Health
- Medscape
Top Things Your Patients Need to Know About Asthma
The roughly 28 million Americans living with asthma are familiar with the challenges of inflammation and narrowing of the airways that affects how the lungs are supplied with air. That's not including the typical symptoms, such as wheezing, shortness of breath, chest tightness, and coughing. And, while medication and lifestyle modifications usually work to help manage these symptoms, full-blown attacks can occur due to airway tightness, and these attacks can be life-threatening. ' Asthma is most often a chronic condition and needs to be thought of that way,' said Morris Nejat, MD, who specializes in adult and pediatric allergy and immunology and is owner and chief medical officer of NY Allergy and Sinus Centers in New York City. Doctors, he said, should do detailed review of a patient's health history and perform breathing and lung function testing to measure how severe the condition is. As a physician, you should encourage patients not to ignore asthma symptoms — no matter what they are. 'Keep an eye on your cough, wheezing, shortness of breath, and chest pain,' is what Diane Cymerman, MD, who specializes in allergy, asthma, and immunology at Stony Brook Medicine in Stony Brook, New York, says patients should be told. 'It's also important that you aren't relying solely on albuterol-type inhalers. If you need an albuterol-type inhaler more than 2 times per week, it's time to see a physician to begin asthma controller medications.' Here are five important things patients should know about asthma: 1. Watch for Early Symptoms If a patient has never been officially diagnosed with asthma, one sign that they might be developing the condition is long-term or persistent dry coughing, particularly at night or upon waking up. Routinely experiencing shortness of breath or chest tightness may also be an early sign of asthma. 'Cough is the most common symptom of asthma and usually starts long before asthma advances to wheezing,' said Angela Duff Hogan, MD, chair of the asthma committee of the American College of Allergy, Asthma, and Immunology. 'Recognizing this early symptom can help stop a full-blown asthma attack.' 2. Learn the Triggers While asthma triggers can sometimes depend on one's age, the long list of factors that can prompt asthma include bacterial sinus and respiratory infections — especially common viral infections. High on the list as well: Pollution, smog, strong odors or fumes, and lung irritants, including cigarette smoke or even sitting near a campfire. 'Exercise and taking aspirin or NSAIDs can also play a role in worsening asthma symptoms,' Hogan said. 'Emotional triggers, including stress, can also prompt asthma.' Other triggers that can exacerbate asthma symptoms include al lergens such as dust mites, roaches, pet dander, pollen, and mold spores. Allergy testing can identify what exactly a patient is allergic to, although that may require a referral to a specialist. Also, Nejat said, suggesting patients keep a diary of symptoms can be extremely helpful, especially when preparing for an appointment with an asthma specialist. 3. Fluctuating Weather It's normal to feel a worsening of asthma symptoms during extreme weather changes. In addition, damp weather spreads pollen and mold, which is yet another asthma trigger. Climate change, including longer pollen seasons and wildfires, have also contributed to breathing issues for those with the condition. ' The weather can certainly affect asthma,' Hogan said. 'Very cold air can cause the muscles that line your lung airways to tighten, and extremely hot temperatures can cause dehydration, which worsens asthma by thickening mucus, making it harder to breathe.' 4. Age of Diagnosis While one can develop asthma at any age, a family history of asthma and the presence of other allergy conditions could play a pivotal role. In addition, adult-onset asthma (meaning a diagnosis in anyone older than 20 years) is currently being studied due to the increase in adults developing asthma. The reasons for the connection aren't exactly clear but may relate to having a history of allergies (around 30% of adult asthma is triggered by allergies), acid reflux, or being exposed to certain irritants or air pollution. 5. Always Be Prepared Treatments for asthma can vary. For patients with well-controlled asthma, treatments can include maintenance inhaler therapy (or a rescue inhaler) for symptoms like coughing or wheezing. Inhaled corticosteroids may also be beneficial. Patients should always have their medicines handy — and never use expired medication. It's also critical that patients both know how to correctly use an inhaler and have an asthma action plan. A patient should never wait until their wheezing to get some relief. 'Let your inhaler be your bestie,' Hogan tells patients. 'Make sure you have it available and use it when you should.' If, however, a patient feels like their usual medications aren't effective, they shouldn't hesitate to seek out another option. 'You'll want to make sure your asthma specialist assesses the cause and offers you the best management of your symptoms,' Cymerman said. One final note for patients: 'Just because you feel 'well' doesn't mean that your asthma is gone or that you should stop your controller medicine,' Hogan said.
Yahoo
16-06-2025
- General
- Yahoo
New Book Guides Readers to Deal with Past Trauma by Putting Them in Control of Their Lives' Direction
Author shares clinical exercises along with short-term and long-term goals STONY BROOK, N.Y., June 16, 2025 /PRNewswire-PRWeb/ -- Forensic psychologist Dr. Bill O'Leary observed that many books dealing with past trauma highlight the common themes of forgiveness and acceptance. While he agrees that these messages are a necessary part of the process, he also says they aren't very practical. "Forgiving someone is cathartic and often makes the forgiver feel better about themselves," said O'Leary, "but they can't effectively use it to overcome the underlying issues." In "Stop Letting Your Past Control You," Dr. O'Leary shares clinical exercises that readers can use to start putting themselves in control of their life's direction. The short-term and long-term goals include can provide present as well as future benefits. "I've been working with people coping with trauma and extreme circumstances for most of my life," said O'Leary. "I've learned that we all have early experiences that we carry with us and influence our self-concept and relationships. Through reflection and a decision to evolve, we can choose what we do about our past experiences and how we let them affect us." O'Leary has been active in the mental health field since 1991 and has been working with victims and perpetrators of violent and sexual crimes for over 30 years. Through consulting, Bill has taught for SUNY Stony Brook, Fordham University, Buffalo State, as well as helping rookies for the New York Giants, and thousands of students through bullying and sexual harassment workshops in schools. "Stop Letting Your Past Control You: A step-by-step guide to becoming who you want to be" By Dr. Bill O'Leary ISBN: 9781665771979 (softcover); 9781665771986 (electronic) Available at Archway Publishing, Amazon, Barnes & Noble and About the author Dr. Bill O'Leary began his own consulting business named People Talk, Inc., in 1999. He teaches on a consultant basis, is a media consultant, a professor at SUNY Stony Brook, Vice President of the Stony Brook Fire Department, and works extensively as a forensic psychologist with law enforcement cases. He lives on Long Island, NY, with his wife and two sons. To learn more, please visit Media Contact Ziggy Goldfarb, Archway Publishing, 4803067065, zgoldfarb@ View original content to download multimedia: SOURCE Archway Publishing Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
USA Today
14-06-2025
- Sport
- USA Today
Has No. 4 seed ever won College World Series? How Murray State might fare at CWS
Has No. 4 seed ever won College World Series? How Murray State might fare at CWS Show Caption Hide Caption Which NCAA baseball teams could blow up the bracket The Montgomery Advertiser's Adam Cole and The Southwest Times Record's Jackson Fuller break down who could wreck the tournament bracket. Murray State is making its first appearance in the Men's College World Series. As a No. 4 seed, Murray State joins a select group of teams to reach the CWS, including 2008 national champion Fresno State. Murray State's first opponent is UCLA in 2025 CWS. OMAHA, NE ― Dan Skirka doesn't actually cut the grass at Murray State's home ballpark, as a viral social media post wrongly asserted, but the Racers' coach has still done more with much less. Murray State, making its fourth NCAA tournament appearance and first since 2003, is in the Men's College World Series for the first time. The Racers stunned in the Oxford Regional, defeating Ole Miss and Georgia Tech, and then again in the Durham Super Regional, defeating Duke. The No. 4 regional seed — the lowest possible entering the NCAA Tournament — will take on UCLA in their opening game of the CWS on June 14 (1 p.m. CT, ESPN) at Charles Schwab Field in Omaha. It's rare for No. 4 seeds to reach Omaha — only three other teams have accomplished the feat — but it's not unprecedented for those teams to make noise (most notably Fresno State, the 2008 national champion). Here's how bottom seeds have fared in the College World Series and how Murray State compares to the teams that made runs: 2008 Fresno State The original mid-major Omaha darling, Fresno State made the most of its 2008 trip to the CWS by winning the whole thing. The Bulldogs weren't a traditional No. 4 seed, as expectations were high entering the season. They were ranked in two polls and picked to win the WAC in the preseason. The roster consisted of four eventual major leaguers. But despite the talent, they got off to an 8-12 start. Fresno State still won the WAC regular season and conference titles, earning an automatic bid to the NCAA tournament. The Bulldogs won a regional at Long Beach State and a super regional at No. 3 national seed Arizona State to advance to Omaha. Despite losing Game 1 of the championship series to Georgia, Fresno State won the final two games by a combined score of 25-11. 2012 Stony Brook Led by future big leaguer Travis Jankowski, Stony Brook was the class of the America East. The Seawolves had a whopping 43-7 regular season record and swept the America East tournament. A team from that conference, typically one of the worst in Division I, had never advanced to Omaha. And Stony Brook didn't have an easy route. The Seawolves were sent to a regional against Miami, and they waded through the losers' bracket to win. Then they rallied to win a super regional against LSU despite dropping the first game in a 12-inning heartbreaker. Stony Brook's run in Omaha ended quickly, as the Seawolves lost to UCLA and Florida State and were the first team eliminated. 2023 Oral Roberts After a so-so start to the season, Oral Roberts got hot at the right time. The Golden Eagles were 14-2 in April and 11-0 in May, and even after being assigned a No. 4 seed in the NCAA tournament, it was clear they were dangerous. Oral Roberts went 3-0 in the Stillwater Regional, defeating Oklahoma State, Washington and Dallas Baptist. Like Stony Brook, the Golden Eagles won their super regional, against Oregon, despite losing Game 1. Oral Roberts was competitive in Omaha, too. The Golden Eagles won their first game against TCU and played a one-run game against Florida. But they ran out of gas and fell in their second game with TCU to end their season. BEST TEAMS IN OMAHA? Ranking the CWS field from best to worst How Murray State compares to previous CWS 4-seeds Murray State wasn't ranked preseason and likely won't have as many major leaguers as the Fresno State team that won it all. But the Racers are more akin to the 2023 Oral Roberts team than the Stony Brook underdogs. Murray State was viewed as one of the strongest — if not the strongest — 4-seeds in the field, and while the Racers have never been on this stage, teams from the Missouri Valley Conference have a good track record. Indiana State and Evansville, the last two MVC champions, advanced to super regionals, and the Sycamores even hosted in 2023. Aria Gerson covers Vanderbilt athletics for The Tennessean. Contact her at agerson@ or on X @aria_gerson.
India.com
31-05-2025
- India.com
Travel in Style: 4 Best Medium Trolley Suitcases You Must Grab From Myntra
Whether you're a frequent flyer or an occasional traveler, choosing the right suitcase makes all the difference. We've rounded up 4 stylish, sturdy, and practical medium trolley suitcases that combine function with fashion to elevate your journey. Safari Accent Polycarbonate 8-Wheel Hard Medium Trolley Suitcase Image Source: Order Now Safari brings a modern and ultra-sleek look with its Accent Polycarbonate Hard Medium Trolley Suitcase. Designed for travelers who value both aesthetics and practicality, this 66 cm suitcase is a stylish yet durable choice. The tough polycarbonate shell and 8-wheel spinner system ensure smooth handling and resilience on the go. Ideal for business trips or weekend getaways! Key Features: Premium Polycarbonate Shell – Lightweight yet sturdy, built to resist impacts. 360-Degree Spinner Wheels – Offers seamless maneuverability in any direction. Spacious Interior – With organized compartments for efficient packing. TSA-Approved Lock – Keeps your belongings secure during international travel. Lacks an expandable zip section for extra packing space. Skybags Beat Pro Hard-Sided Medium Trolley Suitcase Image Source: Order Now Stylish, strong, and functional—Skybags Beat Pro is all about dynamic travel! Its tough outer shell protects your essentials, while the smartly divided compartments inside make packing easy and efficient. Skybags offers this durable yet fashionable suitcase to cater to the adventurous soul who doesn't want to compromise on looks or safety. Key Features: Push-Button Trolley Handle – Ensures comfort during navigation. Multiple Organizer Compartments – Keeps everything neatly in place. Attractive Design – Comes in eye-catching colors and patterns. Dual Wheels – Provide smooth and stable rolling. Not as lightweight as some polycarbonate alternatives. Aristocrat Harbor 8W Medium Trolley Suitcase Image Source: Order Now From one of India's most trusted luggage brands, the Aristocrat Harbor 8W Trolley Suitcase is crafted for the budget-conscious traveler who seeks functionality. With 8 smooth spinner wheels and a durable build, this suitcase ensures comfort and reliability on every trip. It's perfect for short vacations and work travels alike. Key Features: Strong Outer Shell – Built to endure frequent travel and rough handling. 8 Multi-Directional Wheels – Provides hassle-free movement at airports. Expandable Zipper – Allows extra packing space when needed. Adjustable Telescopic Handle – Comfortable grip and height flexibility. The exterior can get scuffed easily with rough baggage handling. Stony Brook by Nasher Miles Dunes Textured Hard-Sided Cabin Trolley Suitcase Image Source: Order Now Compact, textured, and trendy—the Stony Brook by Nasher Miles Dunes Cabin Trolley Suitcase is the go-to choice for smart travelers. With its hard-sided design and textured finish, this suitcase stands out in a crowd. Although it's technically a cabin-size, its medium design and clever interior space make it versatile for short travels or light packers. Key Features: Textured Anti-Scratch Finish – Keeps the case looking new trip after trip. Lightweight Yet Tough – Polycarbonate build resists wear and tear. Double Spinner Wheels – Glides smoothly through terminals and platforms. Compact but Spacious – Smart design fits more than you'd expect. Cabin size limits the amount you can pack for longer trips. Traveling smart starts with choosing the right suitcase. Whether it's the stylish Safari Accent, the bold Skybags Beat Pro, the dependable Aristocrat Harbor, or the compact Stony Brook by Nasher Miles, each suitcase on this list is designed to enhance your travel experience. Myntra now is the best time to invest in high-quality luggage without burning a hole in your pocket. Don't wait pick the one that fits your style and needs and make every journey smoother, safer, and more stylish than ever before. Disclaimer: At IDPL, we help you stay up-to-date with the latest trends and products. It should not be construed as an endorsement to buy. IDPL may make a very small commission from its sale if one chooses to buy the product from any of the links in this article.
